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407-***-**** adtcj5@r.postjobfree.com My LinkedIn Profile

Healthcare Administrator

Versatile and solutions-oriented management professional with over 9 years of extensive experience that includes administration in healthcare and corporate environments. Proven ability to integrate clinical quality and service quality into all aspects of operations and establish a balanced scorecard to monitor and evaluate progress and outcomes. Demonstrated leadership of diverse management teams focusing on aligning program goals to the mission, values, culture and strategic goals of an organization. Solid record of conducting thorough investigations and developing detailed reports to facilitate strategic decision making.

Areas of Expertise:

Healthcare Administration Claims Processing Medicare & Medicaid Regulations Third Party Reimbursement Financial/Revenue Enhancement Office Operations & Administration Team Leadership Resource Allocation Customer Service Analytical Researcher Strategic Thinker Planner Multiple Phone Lines Analytic Skills

PROFESSIONAL EXPERIENCE

Advent Health, Maitland, FL Jan 2021 – Present

Account Representative II – Billing/Collections/Denials

Performs outgoing call to patients insurance to obtain necessary information for accurate billing, collections and correction of denials

Resolves and resubmits rejected claims appropriately as necessary

Process daily and special reports, unlisted invoices and letters, error logs, stalled reports and aging.

Reviews previous accounts documentation, determining appropriate action(s) necessary to resolve each assigned account.

Checking claim status as well as obtaining additional information that is being requested from insurance companies.

Adheres to Central Florida Division South Corporate Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies etc.

NuQuest, Longwood, FL Jan 2017 – Oct 2020

Conditional Payment Coordinator

Provide Conditional Payment Claim (Workers comp) investigation and negotiation services to assist customers in addressing this important MSP compliance obligation

Support attorneys and insurance carriers to provide education and status updates on open files

Interact with regularly with The Benefits Coordination & Recover Center, a government contractor working on behalf of the Center for Medicare Services

Communicate with Medicare to obtain conditional payment estimates, CMS approval status, demands and results of negotiation, and provides Referral Source with updates

ProStaff Agency, Orlando, FL Jul 2016 – Sep 2016

Insurance Reimbursement

Managed hospital billing for Medicaid HMO plans

Examined denials and troubleshooting problems of the claims

Maintained security procedures and confidentially to protect patients right to privacy

Reviewed patient’s files, daily billing reports, assign codes to each given service, and keep up with the submission dates

Examined for Medicaid guidelines compliance and completion before they are submitted

Accessed insurance payments on the web, balance accounts receivable and payable, and deposit funds in the appropriate account

UF Health Cancer Center At Orlando Health, Orlando, FL Jan 2014 – Jun 2016

Sr. Front Office Assistant/Patient Access Specialist (Authorization)

Scheduled patients for diagnostic test (CT scan, Ultrasound’s, Mammogram’s, Echo’s and Bone Scan etc). Check in/out patients and maintaining patient registration

Served as a liaison between the doctor’s offices and answering multiple telephone line and working with the doctor’s one on one

Triaged calls and concerns to the appropriate personnel; scheduled clinic and ancillary appointments as necessary, and provided an atmosphere of genuine concern for patients

Faxed and filed correspondence and adhered to compliance with JCAHO.

Granted authorization for chemotherapy patients and served as a liaison between physicians, patient, and insurances

Interviewed new team members and organized training sessions

Piedmont Heart Institute, Atlanta, GA Nov 2011 – Aug 2013

Patient Access Specialist/Scheduler II

Retrieved new patient’s medical records for 26 of Piedmont doctors.

Called doctors’ offices and hospital to retrieve medical records and uploaded them into EMR, EHR system

Scheduled nuclear stress test, PFT's, echo's, and vascular procedures

Maintained patient registration (new & established) and worked with Citrix, EHR, EMR, and Epic

Trained front office staff on Epic (Super user) with scheduling and registration

Suggested an innovative was of handling errors to keep scheduling running smooth

Assisted with some template building for the doctors

Provided excellent and professional customer service by greeting, answering patient questions via face to face and telephone communications

Scheduled clinic and ancillary appointments as necessary, and provided an atmosphere of genuine concern for our patients. Stay in compliance with JCAHO/OSHA

MEDICAL MANAGEMENT PROFESSIONAL, INC. (MMP), Gainesville, GA Jun 2008 – Nov 2011

Medicaid Biller/Deposit Prep

Submitted claims to Medicaid & Medicare and other major insurance companies that include but are not limited to: Blue Cross Blue Shield, CIGNA, & etc. Examining denials and troubleshooting problems of the claims

Maintained security procedures and confidentially to protect patients right to privacy

Examined for Medicaid guidelines compliance and completion before they are submitted.

Submitted claims in a timely manner to get payments quickly

Reviewed daily billing reports and keep up with the submission dates

Accessed insurance payments on the web, balance accounts receivable and payable, and deposit funds in the appropriate account

Florida Cardiology, Oviedo, FL Medical Assistant May 2007 – Apr 2008

Florida Physician Medical Group, Winter Park, FL Medical Assistant/Front Office Jan 2004 – Apr 2007

Orlando Pulmonary, Orlando, FL Medical Assistant Jul 2002 – Jun 2003

Orange County Official Records, Orlando, FL Document Verification Nov 2000 – Apr 2002

EDUCATION

University of Phoenix- Bachelor of Science - Health Care Administration, June 2011

Career Training Institute - Diploma-Medical Assistant, Jul 2001 – Sept 2002

Jones High School - High School Diploma, May 1999

PROFESSIONAL TRAINING

International Classification of Diseases (ICD-10) Training, Gainesville, GA (Feb 2011)

TECHNICAL SKILLS

Microsoft Office Software (Word Processing)/E-mail

Copiers/Scanners/Typing/Ten Key

EMR/EHR/Epic (Super User)/NexGen/Sunrise/Clinic/CPA etc

TALISHA REDDING

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